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Navy and Marine Corps Medical News 

December 15, 2000 

Navy and Marine Corps Medical News (MEDNEWS) is a weekly 
compendium of news and information contributed by commands 
throughout the Navy medical department. Information contained in 
MEDNEWS stories is not necessarily endorsed by Navy Bureau of 
Medicine and Surgery (BUMED) , nor should it be considered 
official Navy policy. 

BUMED distributes MEDNEWS to Sailors and Marines, their 
families, civilian employees and retired Navy and Marine Corps 
families. Further distribution is highly encouraged. 

Stories in MEDNEWS use these abbreviations after a Navy 
medical professional's name to show affiliation: MC - Medical 
Corps (physician) ; DC - Dental Corps; NC - Nurse Corps; MSC - 
Medical Service Corps (clinicians, researchers and 
administrative managers) . Hospital Corpsmen (HM) and Dental 
Technician (DT) designators are placed in front of their names. 

Contents for this week's MEDNEWS: 

- TRICARE proposes simplified pharmacy co-payment schedule 

- Safety, common sense help ensure happy holidays 

- Medevac is a team effort aboard GW 

- Rota finds way to celebrate women, making health promotions effective 

- Local high school students train at NH Halyburton 

- TRICARE question and answer 

- Healthwatch: Oh! My head feels like it's going to explode! 

HEADLINE: TRICARE Proposes Simplified Pharmacy Co-Payment 

WASHINGTON, Dec. 12, 2000 — TRICARE officials propose to 
simplify co-payments for prescription drugs in accordance with 
the recent year's appropriations act. The new co-payments will 
be uniform for all beneficiaries and based on whether a generic 
or brand-name medication is dispensed. 

The current co-payment structure is complex and confusing, 
said Army Lt. Col. William G. Davies, director of DoD Pharmacy 
Programs, part of the TRICARE Management Agency in Falls Church, 

"We're trying to improve the TRICARE pharmacy benefit to make 
it simpler to understand and more uniform, consistent and 
equitable for everyone, " Davies said. 

If the proposal is approved, he said, it would be kicked off 
DoD-wide April 1, 2001, when the TRICARE Senior Pharmacy program 

is operational. 

Under the proposed changes, beneficiaries would pay $3 for 
generic prescription drugs and $9 for brand-name drugs at 
TRICARE-af filiated retail drug stores for up to a 30-day supply 
or through the National Mail Order Pharmacy program for up to a 
90-day supply. 

TRICARE Prime enrollees who choose to obtain their 
prescription drugs from non-TRICARE affiliated retail outlets 
would continue to pay a 50 percent point-of-service fee after 
meeting their deductible. All others would pay the greater of a 
20 percent co-pay or a $9 charge per prescription. 

"There are cost savings available to the majority of the 
beneficiary population depending on how the prescription drugs 
are obtained, " Davies said. 

Prescriptions obtained through the mail program are generally 
less expensive, he noted, because the government gets federal 
pricing. Also, the patient can receive three times the quantity 
for the same co-pay as through a TRICARE retail pharmacy. 

Davies noted there is no co-pay for prescriptions filled at 
military hospital and clinic pharmacies. This, he said, is the 
best financial value for beneficiaries. 

Beginning April 1, 2001, military retirees age 65 and over 
will be provided the same pharmacy benefit offered to 
beneficiaries under age 65. 

Davies said the TRICARE Senior Pharmacy program would replace 
both the Pharmacy Redesign Pilot programs conducted since July 
at Fleming, Ky., and Okeechobee, Fla. 

Persons who turn 65 before April 1, 2001, may participate in 
the pharmacy program without having Medicare Part B, but those 
who turn 65 after April 1 must be enrolled in Medicare Part B to 
participate, officials noted. 

- USN - 

HEADLINE: Safety, Common Sense Help Ensure Happy Holidays 

By Staff Sgt . Kathleen T. Rhem, American Forces Press Service 

WASHINGTON -- I've always felt there are two important things 
to keep in mind during the holidays: Don't let baby mistake the 
light-up nose on your Rudolph decoration for her "Baby's 1st 
Christmas" pacifier, and go easy on the rum if you share the 
eggnog with your cat. 

But, believe it or not, DoD safety officials have tips they 
insist are better than mine. 

Christmas trees are central to many families' holiday 
celebrations and yet can be among the most dangerous . Keep 
these tips in mind when selecting and decorating yours : 

- Think fresh! Dry trees are an extreme fire hazard. Only a 
few needles should fall when you shake a fresh tree, and needles 
should bend but not break. 

- Keep your tree outside in a bucket of water until you're 
ready to decorate. 

- Cut a two-inch diagonal slice off the bottom before 
bringing it inside and keep water in the stand. A diagonal cut 
allows your tree to "drink" more. 

- Keep your tree out of traffic areas and at least three feet 
from heat sources and fireplaces. 

- It's easy to assume that your lighted decorations are OK 
this year because they worked when you put them away last year. 
Not so. Inspect them carefully before use, and be especially 
alert for worn or cracked wires . Make sure all light sets have 
an Underwriters Laboratory (UL) or Factory Mutual (FM) label. 
Also avoid overloading outlets and extension cords. 

The Centers for Disease Control and Prevention in Atlanta 
suggest the following safe-handling tips for your holiday eats . 
Additional information can be found on the Internet 
<www . cdc . gov> 

- Wash hands before and after preparing food, especially 
after handling raw meat and poultry. 

- Keep raw meats and poultry separate from other foods . 
Clean and disinfect cutting boards and kitchen surfaces after 
preparing food, and use different plates and utensils for cooked 
food from those used for the raw foods. 

- Refrigerate or freeze perishable foods right away after 
coming home from the store. 

- Thaw frozen food in the refrigerator or microwave oven, not 
on the countertop. 

- Keep hot foods hot and cold foods cold. Don't leave foods 
out at room temperature for more than two hours. 

- Identify a designated driver early or arrange for taxis 
when you gather with family, friends and coworkers to celebrate 
the holidays. If you're the party host, serve plenty of food 
and nonalcoholic beverages. Of the 41,967 traffic fatalities in 
1997, 39 percent were alcohol-related, according to the CDC ' s 
National Center for Injury Prevention and Control. 

Other holiday safety tidbits gleaned from various sources 
are : 

- Ensure smoke detectors work and have a fire extinguisher 
handy. Consider giving these lifesaving devices as holiday 
gifts to friends and family members . 

- Don't burn wrapping paper in your fireplace. The colored 
inks can produce toxic fumes . 

- Being alone this time of year can be depressing. Don't let 
someone you know spend the holidays alone. 

- Choose age-appropriate gifts for children. Adhere to 
warning labels and age restrictions on packages. The Consumer 
Product Safety Commission has oodles of information on its 
Internet site <> that lists product recalls as well. 

- USN - 

HEADLINE: MEDEVAC is a team effort Aboard GW 

ABOARD USS GEORGE WASHINGTON (CVN 73) — Your alarm screams at 
you. It's 0530. An hour before muster. You hit the snooze 
button again and again until you realize you've got just 10 
minutes to get to work. You jump from your rack, and in mid- 
flight, you remember you sleep in the top rack. Your landing is 
soon announced over the IMC: "Medical emergency, medical 

emergency in compartment ..." You've broken your leg. Now you 
get to take a ride to the beach. 

"Ninety percent of all medical evacuations are orthopedic 
injuries," said HM2 (SW) Bobbie Turner, GW s MEDEVAC coordinator. 
"There are no orthopedics on the ship. That's why when someone 
needs a bone set or a cast on their leg they are medevaced off 
to receive the care they need." 

"If a patient needs further care beyond the facilities of the 
ship, we need to get them somewhere they can be treated, " said 
Cmdr. Paul Rocereto, Senior Medical Officer (SMO) . "That's the 
purpose of a MEDEVAC." 

When there's a MEDEVAC, the Medical Department pulls 
together. Turner said. Collecting the patient's health, dental 
and service records, TAD cost orders, ID card. Smart Card, and a 
bag of clean clothes, the whole department helps the MEDEVAC 
Team. Personal items, medications. X-ray prints, and a float 
coat and cranial are among the things packaged with the patient. 
And depending on the patient's condition, it might have to be 
done in 30 minutes. 

Sometimes there's a Sailor hospitalized in a liberty port. 
That's when MEDEVAC patients return to the ship, rather than 

"Our number one priority is trying to get [the patient] back 
to the ship," Turner said. 

When a patient is in a hospital, the SMO or the duty flight 
surgeon will visit them. He'll determine if the ship can treat 
the patient, but the commanding officer has the final say on 
whether a patient will be evacuated. 

If a MEDEVAC is needed. Turner contacts Theater Patient 
Movement Requirement Center (TPMRC) , a part of the Air Force 
that coordinates all MEDEVACS in Sixth Fleet's area of 
responsibility (AOR) . 

"A MEDEVAC takes the highest priority, " said Assistant Air 
Ops. Officer Lt. Cmdr. Joe Parks. "I've got C-2s, H-53s, H- 
60s, and other helicopters in the battlegroup that are at our 
disposal in case of an emergency." 

Probably the riskiest place to have a MEDEVAC is during an 
Atlantic transit because the ship is so far from land. Parks 
said. "Even in the middle of the Atlantic we are within range 
of the Azores to the east, and Bermuda to the west," he added. 

Lt. Gabe Soltero, a pilot with HS-15, recalls a time he was 
involved in a MEDEVAC. 

"The patient's condition had worsened dramatically so 
everyone worked together, " Soltero said. "He was in a 
stretcher, and the doctor, a flight surgeon, came along on the 
flight to take care of him. From the SMO's advice, I had to 
make sure I didn't go too high in altitude because of the 
patient's condition. After sticking to the valleys and avoiding 
high altitudes, we flew across Italy, from the Adriatic to 
Naples, in an hour." 

After coming back to GW and concerned about his last 
passenger, Soltero kept getting updates from the SMO. 

"When I heard the guy made it, it was such a good feeling, " 
Soltero said. "I take my hat off to those in the Medical 

Department. They're the ones who really take care of the 
patients . " 

- USN - 

HEADLINE: Rota finds way to celebrate women making health 
promotions effective 

By Heather King Navarrete, Naval Station Rota, Spain 

ROTA, SPAIN -- With all of the health awareness issues that 
Americans encounter on a daily basis, it is becoming harder and 
harder for health promoters to call the public's attention 
toward important health-related issues. Recently, one group of 
health promoters at Naval Hospital Rota was able to capture the 
attention of 200 women and leave a lasting impression. The 
opportunity came about when a private, non-profit organization, 
spear-headed by Lt . Mari Schulz, a Navy audiologist, hosted a 
one-day women's forum. 

The forum, "Womanhood: The basics and beyond," included 68 
workshops that ranged in a variety of topics from health and 
finances to beauty and crafts and provided a chance for women to 
network . 

"It was an event that meshed contributions from all base 
resources into one beautifully packaged educational and fun 
day," said Schulz. 

During opening remarks, Breast Care Initiative Facilitator LT 
Elizabeth Escalera and Mammography Technologist Kimberly Plourde 
seized the opportunity to educate 200 women on breast cancer and 
the importance of early detection. Escalera and Health Promoter 
Betty Murphy set up a station in the banquet hall, which 
provided participants a chance to speak with health experts 
individually and to collect literature on the subject. There, 
Escalera completed nearly 100 breast cancer risk assessments and 
taught one of the 45-minute seminars offered. 

The marketing opportunity the conference provided was 
invaluable, said Escalera. Nearly three months after the event, 
Escalera is still seeing a response. 

"I still have women that were at the conference coming to the 
clinic, seeking guidance and information regarding breast cancer 
prevention and detection," she said. 

The information was well received, said Murphy, because it 
was provided in a forum where women would be open to the 
information . 

"When you have a big forum like that, it is helpful because 
it gives you a chance to get the message out in a different 
way," she said. "[As a health promoter], you are always looking 
for innovative ways to get the message out." 

The event proved that careful marketing really does make a 
difference, said Schulz. 

- USN - 

HEADLINE: Local high school students train at at Halyburton 
Naval Hospital 

By Cpl. Jason Morris, MCAS Cherry Point, N.C. 

CHERRY POINT, NC — Eleven seniors from Havelock High School 
are fulfilling one of many clinical requirements for the state 
certification for certified nursing assistant at Halyburton, 
according to Laurence Tarnowski, Havelock High School teacher. 

"The CNA-1 is an entry-level position to health care," said 
Tarnowski. "They're in their last program in a series to attain 
the CNA . " 

The high school program contains three-levels. The course 
begins in the student's sophomore year when they take the 
selective course called biomedical technology. If the students 
want to go further, they need to take a prerequisite course in 
their junior year, which is primarily anatomy and physiology, 
according to Tarnowski. 

"This particular course is a double-period course, which is a 
three-hour block of time," said Tarnowski. "So we spend the 
first nine weeks learning basic skills. The second nine weeks, 
we spend in clinical rotation: three-weeks at Britthaven 
Convalescent Center, and about seven-weeks at the naval hospital 
rotating through the different departments." 

Members of the Halyburton staff appreciate the students' 
willingness to help. 

"I think it's a great program," said Petty Officer 2nd class 
Willie McDonald, Naval Hospital Halyburton physical therapy 
technician. "The students are very helpful to us and they get a 
lot of first hand knowledge about the medical field." 

More than half of the current students in the class are 
military family members stationed here with their parents. 

"This course is a good start," said Matthew Merrill, son of 
CWO-4 Mark R. Merrill, Marine Aircraft Group 14 centralized 
administration director. "It's a real good learning experience. 
I plan on taking this knowledge into the medical field." 

"I think it's an excellent class," said CWO-4 Merrill. "It 
gives the students the opportunity to observe and experience the 
career options in the medical field." 

"This is an exceptionally good group," said Tarnowski. 
"They're very ambitious and very inquisitive. It's really a 
boost for me, after teaching these past six years. This is 
probably one of the better groups I've had. 

"They're very trustworthy and their integrity is beyond 
question. It has to be so, working in health care," Tarnowski 
added . 

- USN - 

HEADLINE: TRICARE Question and Answer 

Question: What is the National Mail Order Pharmacy Program 
(NMOP) ? 

Answer: The NMOP is DoD's new timesaving and inexpensive mail 

order service for maintenance prescriptions. Beneficiaries can 
receive free delivery to a home, temporary stateside address, or 
APO/FPO addresses. 

- USN - 

HEALTHWATCH: Oh! My head feels like it's going to explode! 
By Lt . Cmdr. Mark Kiefer, MC, Naval Hospital Pensacola, Fla . 

Your sinuses hurt. You have a fever, and discolored nasal 
discharge. You must have a sinus infection, right? Not 
necessarily! Before you spend the time and effort to see your 
doctor, please take a moment to consider your options. 

Why do my sinuses hurt? Sinus pain does not mean you have a 
sinus infection. Viruses that infect the nose, hay fever, or 
allergies often involve the sinuses. The pain is due to 
blockage of the sinus openings preventing them from draining 
properly . 

Why do I have a fever? Fever does not mean you have a 
bacterial infection. A fever less than 101 degrees is common in 
colds, and higher fevers of 101 to 104 are often seen in flu- 
like illnesses. 

What about my yellow and green nasal discharge? Green nasal 

discharge does not mean bacteria cause your infection. The 
green or yellow color of your nasal secretions indicates your 
body is successfully fighting infection. Inflammatory cells 
that fight infection cause the color. Green and yellow nasal 
discharge is often seen in colds that are getting better and in 
people with hay fever and allergies . 

What are some of the ways I can tell a viral illness from a 
true bacterial sinus infection? Symptoms of a viral infection 
of the nose and sinuses include clear to yellow or green nasal 
discharge, low grade fever, headache, sinus pain, muscle aches 
and sore throat. Symptoms that last longer than 10 days with no 
improvement or symptoms that worsen over 5 to 7 days may 
indicate a bacterial sinus infection. Additionally, nasal 
discharge that looks like the contents of a pimple (pus) may 
indicate a sinus infection. 

Why not just treat my symptoms with an antibiotic? 
Antibiotics will not cure viral infections and can be harmful if 
given inappropriately. Antibiotics disrupt cell walls and 
unique reproducing mechanisms in bacteria. Viruses do not 
contain these cell walls or reproducing mechanisms, and 
therefore will not respond to antibiotics. Despite these facts, 
it is estimated that 20-60 percent of patients with the common 
cold leaves their physician's office with a prescription for an 
antibiotic . 

What possible harms can an antibiotic cause? Overuse of 
antibiotics can lead to the development of bacteria that do not 
respond to the usual antibiotics that we currently use to treat 
infections. We are currently seeing an alarming rise in 
bacteria that have developed this resistance. This is largely 
due to treating people who have viral infections unnecessarily 
with antibiotics . 

If you routinely receive antibiotics for colds and viruses, 
you are far more likely to become infected with these resistant 
bacteria. Additionally, antibiotics have side effects that 
include nausea, diarrhea, skin rash, and allergic reactions . 
Some allergic reactions can be severe enough to require 
hospitalization . 

Can I prevent an infection by taking the antibiotic before I 
get sick? Treating viral infections with antibiotics will not 

prevent bacterial infections. Trying to prevent bacterial 
infection by prescribing antibiotics can be harmful, as it 
increases the likelihood that you will get an infection with a 
bacteria that will not respond to the antibiotics we use. 
Furthermore, most patients recover from cold and virus symptoms 
in 10 to 14 days. 

What medications and treatments have been proven to help 
relieve the symptoms of cold and viral infections of the nose 
and sinuses? Cool mist vaporizers may relieve symptoms. 
Tylenol and Motrin can be used for fever and pain. Saline 
rinses and decongestants (like Afrin spray and Sudafed tablets) 
may help. Some studies show a possible benefit from Zinc 
Gluconate (Cold/Eeze) when taken every 2 hours while you have 
symptoms. Antihistamines and nasal steroids are not 

When should I contact my doctor? If you have symptoms that 
may suggest a bacterial sinus infection, you should consider 
seeing your doctor. Three out of every five patients with 
bacterial sinus infection will get better with no treatment. 
Patients with chronic illnesses (such as diabetes or cancer) an 
patients taking drugs that suppress their ability to fight 
infection (such as oral steroids) should see their doctor early 
if they develop symptoms of infection. 

Finally, if you develop paralysis of the face, double vision 
swelling over the forehead or swelling around the eye, with 
symptoms of sinus infection, you should see your doctor 

If you have other questions about sinusitis, contact your 
doctor. Be proactive in your health. Insist that your doctor 
explain the need for an antibiotic before accepting a 
prescription you may not need. 

(Lt. Cmdr . Mark Kiefer is a board-certified Family Practice 
physician at Naval Hospital Pensacola, Fla.) 


Comments and ideas for MEDNEWS are welcome. Story Submissions 
are highly encouraged. Contact MEDNEWS editor. At email:; telephone 202-762-3218, (dsn) 762, or 
fax 202-762-3224.